Ultra-Processed Food Consumption, Diet Quality, and Nutritional Literacy among Adolescents in Eastern Türkiye: A Cross-Sectional Study

Abstract

Ultra-processed foods (UPFs) have become increasingly prevalent in the diets of adolescents and are often associated with unfavorable dietary patterns and health outcomes. This study aimed to examine the relationships among UPF consumption, diet quality, nutritional literacy, and anthropometric indicators in adolescents. This cross-sectional study included 338 high school adolescents aged 13-17 years. Participants completed a questionnaire assessing socio-demographic characteristics, a food frequency questionnaire, and the Adolescent Nutritional Literacy Scale, while the researcher collected the participants' anthropometric measurements. UPF consumption was classified using the NOVA system, and diet quality was evaluated using the Healthy Eating Index-2015. UPFs accounted for 26.98% of total daily energy intake. When analyzed by quartiles (Q1: <= 18.53%, Q4: >= 35.07%), higher UPF consumption was associated with higher intakes of total fat, saturated fat, and total sugars, as well as vitamins B2 and B12 and calcium. However, no significant associations were observed between UPF consumption and diet quality or nutritional literacy. Most anthropometric indicators did not differ significantly across UPF consumption quartiles; however, body mass index-for-age z-scores differed significantly among male adolescents (P=0.026). UPFs constituted a substantial proportion of adolescents' energy intake and were associated with the increased intake of several nutrients that should be limited. The absence of associations between diet quality and nutritional literacy suggests that commonly used assessment tools may not fully capture the dietary impact of UPFs, highlighting the need for more sensitive evaluation approaches.